Provider Demographics
NPI:1316522238
Name:WARD, MALLORY RACHAEL (MS)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:RACHAEL
Last Name:WARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 N NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2038
Mailing Address - Country:US
Mailing Address - Phone:224-558-5047
Mailing Address - Fax:
Practice Address - Street 1:5215 N NEWCASTLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2038
Practice Address - Country:US
Practice Address - Phone:224-558-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator